From the Guidelines
Low testosterone levels in females can be caused by several factors, including polycystic ovary syndrome (PCOS), which is a common endocrine disorder affecting 4-6% of women in the general population, and is characterized by hyperandrogenism, chronic anovulation, and polycystic ovaries 1. When evaluating women with low testosterone levels, it is essential to consider the potential causes, including medical conditions, medications, and lifestyle factors.
- Medical conditions such as PCOS, adrenal insufficiency, hypopituitarism, and hypothyroidism can disrupt hormone production and lead to low testosterone, as evidenced by the abnormal findings in Table 2 of the study, which highlights the importance of investigating women with epilepsy and symptoms or signs of reproductive endocrine disorder 1.
- Certain medications like oral contraceptives, corticosteroids, and some antidepressants may suppress testosterone production, and valproate, an antiepileptic drug, has been shown to cause modest elevation of testosterone levels 1.
- Lifestyle factors such as chronic stress, poor nutrition, extreme weight loss, excessive exercise, and eating disorders can also lower testosterone levels by affecting the body's hormone regulation.
- The study also highlights the importance of measuring serum levels of various hormones, including LH, FSH, prolactin, progesterone, testosterone, and androstenedione, to investigate women with symptoms or signs of reproductive endocrine disorder 1. It is crucial to consult a healthcare provider for proper evaluation and management of low testosterone levels in females, as testosterone replacement therapy might be considered in some cases, although it is not FDA-approved specifically for women and must be carefully monitored for potential side effects.
From the Research
Causes of Low Testosterone in Females
- Testosterone deficiency in women may result from various conditions, including oophorectomy, adrenalectomy, adrenal disease, pituitary disease, HIV infection, premature ovarian failure, Turner's syndrome, and the use of high-dose corticosteroids and some estrogen preparations 2
- Simple aging and natural menopause may also contribute to testosterone deficiency in some women 2
- Polycystic ovary syndrome (PCOS) is an endocrine disorder that can affect testosterone levels in women, with management options including lifestyle changes and combined hormonal contraceptives (CHCs) 3
- The use of CHCs can suppress luteinizing hormone secretion and reduce free testosterone levels, which may contribute to low testosterone in females 3
- Other factors that may contribute to low testosterone in females include the use of oral contraceptive pills (OCPs), which can affect a wide variety of reproductive/metabolic hormones 4, 5
Hormonal Contraceptives and Testosterone Levels
- Combined oral contraceptives (COCs) can increase the risk of venous thromboembolism (VTE) and may have potential cardiometabolic risks, but can also provide benefits such as reducing the risk of endometrial cancer and improving hyperandrogenism 5
- Metformin and COCPs are commonly used in the management of PCOS, with metformin lowering insulin and triglycerides compared to COCPs, and COCPs being inferior for free androgen index (FAI) and sex hormone binding globulin (SHBG) compared to combination treatment 6
Medical Conditions and Testosterone Levels
- PCOS is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology, which can affect testosterone levels 3, 5, 6
- Other medical conditions, such as adrenal disease, pituitary disease, and HIV infection, can also contribute to testosterone deficiency in women 2